BUSINESS CASE

Smarter blockchain for healthcare

BUSINESS CASE

Smart blockchain and healthcare

Many countries suffer from a fractured landscape of Electronic Medical or Health Record (EMR or EHR) systems. Patient privacy and ownership are important user concerns, while data collection, interoperability and exchange, claims processing and fraud detection remain challenges for both healthcare providers and payers.

It is not uncommon for large enterprises to have critical data spread across different systems that don’t communicate well with one another. In the healthcare industry, those interoperability issues can lead to payment delays and other problems, such as patients not having access to a complete aggregated view of their health, or patient data privacy.

The American Recovery and Reinvestment Act required all public and private health care providers to adopt electronic medical records (EMR) by January 1, 2014. This EMR mandate spurred significant growth in the availability and utilization of EMRs. Despite this, the vast majority of these systems do not have the capacity to share their health data.

By leveraging the use of smart apps and smart contracts the Sky Republic Platform can play a role in the following use cases.

CASE SNAPSHOT

Potential use cases and benefits for the healthcare industry

DATA EXCHANGE, CLAIMS, & FRAUD DETECTION

Shared access to health records improves care coordination

Patient identity management

Secured storage of genomics, patient data

Automate claims & verify billing to reduce costs, and
detect fraud

DRUG SUPPLY CHAIN INTEGRITY & REMOTE AUDITING

Minimize drug counterfeiting & theft

Improve pharma supply chain finance

Drug supply chain provenance

Better visibility for marketing efforts & patient programs

DATA EXCHANGE, CLAIMS, & FRAUD DETECTION

Shared access to health records improves care coordination

Patient identity management

Secured storage of genomics, patient data

Automate claims & verify billing to reduce costs, and
detect fraud

DRUG SUPPLY CHAIN INTEGRITY & REMOTE AUDITING

Minimize drug counterfeiting & theft

Improve pharma supply chain finance

Drug supply chain provenance

Better visibility for marketing efforts & patient programs

CLINICAL TRAILS & POPULATION HEALTH RESEARCH

Faster regulatory compliance approvals

Promote research commons & remunerative models

Manage IP/R&D asset transactions

Clinical trial data integrity & provenance

CYBER SECURITY & INTERNET OF MEDICAL THINGS (IOMT)

Unique identifiers for medical devices & assets

Secured & selective access to patient generated health data

Smart medical asset management

Remote & autonomous diagnosis

CLINICAL TRAILS & POPULATION HEALTH RESEARCH

Faster regulatory compliance approvals

Promote research commons & remunerative models

Manage IP/R&D asset transactions

Clinical trial data integrity & provenance

CYBER SECURITY & INTERNET OF MEDICAL THINGS (IOMT)

Unique identifiers for medical devices & assets

Secured & selective access to patient generated health data

Smart medical asset management

Remote & autonomous diagnosis

Smarter blockchain for healthcare

Share data securely & improve interoperability

As a secure transaction layer, the Sky Platform can store two types of information in smart contracts: (1) data itself or (2) links or pointers to data stored in separate, traditional databases (sometimes referred to as “data lakes”). Storing medical information directly in the smart contract ensures that the information is fully secured by the Platform’s properties and is immediately viewable to those permissioned to access the data. At the same time, keeping large data files (such as x-ray or MRI images) in providers systems, outside of the smart contract, avoids HIPAA compliance or central storage issues.

Creating interoperability requires frictionless submission and access to view data. As such, the Sky Platform could serve as a transaction layer for organizations to submit and share data using one secure system. This will be most effective if a specific set of standardized data were to be stored directly in smart contract for immediate, permissioned access, supplemented by links to stored data when necessary. A standardized data set could include information such as demographics (gender, date of birth, other data), medical history (immunizations, procedures), and services rendered (vital signs, services performed, and other data).

Once a standardized set of health care information is established, the specific data fields can be validated by a smart contract, as well as required approvals prior to storage. Each time a patient interaction occurs, healthcare organizations will pass information to the smart contract and it will verify that valid information has been submitted. As an example, the smart contract can stipulate that all fields need to be provided prior to storage, or that a specific field must contain a particular data type (e.g. numerical) to be valid. Once the smart contract validates that the correct data fields have been submitted, it will store the transaction in its repository for others to retrieve.

Streamline claims processing & adjudication

The Sky Platform can greatly simplify claims processing overhead across providers and insurers. Initiatives to aggregate medical claims such as All-Payer Claim Databases (APCDs) about health care use and cost could also be made easier to collect using event driven blockchain, contributing to more effective policy decisions. Identity management systems can be used to prevent fraudulent and duplicate claims, and a smart contract could be used to simplify claims settlement and accounting.

By automating the majority of claim adjudication and payment processing activities, the Sky Platform could reduce administrative costs and time for both providers and payers. It can take up to 90 days for a claim to be processed as it moves from intermediary to intermediary. Since most medical data isn’t interoperable, information requests are sent back and forth between middlemen who manually evaluate each claim. This chain of custody can expose sensitive medical information to more than 300 different sets of eyes. And the costs are exorbitant: According to the Institute of Medicine, data inefficiencies within the healthcare industry will cost about $315 billion by 2018.

The Sky Platform could offer a much more streamlined, secure, and cost-efficient way of handling medical claims. By allowing every party to interact within the same system, information requests can be handled quickly and unilaterally. Fewer intermediaries are required to log information which means fewer eyes on your personal information. Similarly, strict access permissions protect your medical privacy from unauthorized viewers. EDB also makes this process more transparent as patients, providers, and payers can see the history of each claim as it moves between parties. Lastly, payments can be authorized and distributed automatically using Sky contracts.

Billing management & fraud detection

An estimated 5-10% of healthcare costs are fraudulent, resulting from excessive billing or billing for non-performed services. For example, in the United States alone, Medicare fraud caused around $30 million in losses in 2016. The Sky Platform could minimize these medical billing-related frauds.

The enhanced security and transparency the Platform can provide may also drastically reduce the amount of fraud that slips through the defenses of public and private payers. When entities must have current and authenticated identities before a transaction is approved, the ability to push suspect claims through the reimbursement process is diminished.

Payers with access to a patient’s complete medical record and all of the individual’s approved providers would be more able to identify suspect claims or payment requests that do not match the patient’s documented conditions or normal care habits. Proactive monitoring of these patterns could inform fraud detection systems that rely on machine learning to continually improve their sensitivity, allowing payers to avoid the costly “pay-and-chase” situation.

All of these use cases, however, assume broad adoption of distributed ledger technology that encourages universal data sharing and a willingness for providers, patients, and health plans to trust one another with their sensitive information.

Ensure drug supply chain integrity

The Sky Platform is engineered to provide enhanced track-and-trace capabilities across the extended supply chain, as well as establish drug provenance. For more information on the role the Platform can play in this scenario, click here.